In this summer of budget stresses for local governments, most are doing what they always have done when money gets tight: eliminating services, cutting staff, talking about hiking the property tax rate.
Credit Clearwater for thinking outside the box. On Friday the city will open a medical clinic exclusively for city employees and their dependents. It's the city's creative way of trying to slow runaway health care costs by offering an alternative to fee-for-service care.
Clearwater is the first Tampa Bay city to open its own clinic, but other cities struggling with high employee health care costs are watching to see how it goes. Dunedin already has shown interest in sharing the clinic with Clearwater.
The city will not directly operate its clinic, but has hired a company that specializes in that work, CareATC of Tulsa, Okla. CareATC hires the doctors, handles the administrative work and has a medical director who oversees the clinics' medical services. A 19-page contract spells out the relationship between the city and CareATC. The city covers the clinic's operational cost and pays the company an administrative fee.
The investment required to set up and operate Clearwater's clinic is not insignificant, though in the beginning it will operate in leased space and have only one doctor, one nurse practitioner and three medical assistants. The city took $1.75 million out of its insurance fund reserves to pay the clinic costs for the remainder of this year and next year. But the city isn't discouraged by the start-up costs. According to Clearwater human resources director Joe Roseto, similar clinics elsewhere have saved $2 to $3 for every $1 invested in them.
The clinic will be available to all city employees, retirees and their dependents who are covered by the city's health insurance. They will not be required to use the clinic for their health care, but there are several reasons they might choose the clinic.
No. 1, it will be free. Employees now have a $25 co-pay when they go to the doctor under their Cigna health insurance plan. But there will be no co-pay for clinic visits. And if the employee needs a medication the clinic stocks, it will be free, too.
Another incentive: Employees who visit the doctor during the work day will not have to take sick leave if they use the clinic.
The clinic, which will be in a medical building near downtown Clearwater, will provide disease management, treatment of injuries and infections, urgent care, immunizations, prescriptions, wellness programs and physicals. Employees who need more specialized care will go to specialists using their regular city health insurance coverage. Children under 2 will not be treated in the clinic.
The clinic also will provide health risk assessments, which the city considers key to driving down health care costs over the long term. The city will encourage all clinic patients to get an assessment and will hand gift cards to the first 250 who get a risk assessment.
Patients getting assessments will fill out a questionnaire and will be given lab tests to determine the state of their health. If the assessment uncovers a potential problem — for example, high cholesterol that could lead to a heart attack — the patient will be treated for it. That's how the city hopes to reduce the catastrophic insurance claims that follow major health crises like heart attacks and strokes.
Roseto acknowledges that some employees were suspicious of the city's intentions at first. They wondered if the city would get access to their medical records, but Roseto said most skeptics have been reassured that the city has no interest in their medical records and that the federal Health Insurance Portability and Accountability Act of 1996 requires doctors to keep medical records confidential. Now, he said, employees are excited about having a new, inexpensive and convenient alternative.
Perhaps they also realize that every dollar the city saves on health care is a dollar that can be used to save city employees' jobs and the services they provide to the public.
Diane Steinle is editor of editorials for the North Pinellas editions of the St. Petersburg Times.